How (Not) To Talk About Suicide

I apologize for the rough and rambly nature of this article – it’s been a while since I’ve written anything, and I just wanted to capture the inspiration while it was there!

I won’t blame you for feeling afraid when the issue of suicide is raised. I won’t blame you for feeling confused, for finding it hard to understand how someone could go through with killing themselves. I certainly won’t blame you for feeling saddened, angry, or disgusted by the prospect of this tragic loss of human life and potential. As a suicide prevention therapist I have felt all of these emotions and will continue to do so.

I ask you today to accept responsibility for how you react to these emotions, and to consider reacting differently. I ask you to help foster a hopeful and meaningful conversation about suicide, as opposed to one full of stigma and discrimination. I do this believing wholeheartedly that to do so will change and potentially save lives.

I work with and think about the issue of suicide every day. It is without doubt a challenging topic. I won’t lie and say that there haven’t been times when I’ve gone home feeling like a shell drained of all empathy, or that I haven’t burst into incoherent sobbing when trying to tell my wife about a particularly tragic day.

Fortunately, that’s pretty rare. I spend considerably more time being inspired by the strength and the courage of the clients – all of whom are suicidal – I have the privilege to work with. Their stories of hardship – of abuse; of social isolation, aggression, and humiliation; of debilitating mental illness; of loss – are all too common. By no means does it end there; I see more issues than I could fit into a post this size. The mere fact that they show up to sessions at all suggests these kids are resilient. But just because they’re at risk for suicide doesn’t mean it isn’t possible to work with them in an effective, safety-focused way.

Fear dilutes our goal of helping others from a moral obligation to a convenient desire.

The unfortunate and uncomfortable reality is that my profession (that would be counsellors in general, not the suicide prevention community) largely shies away from the issue of suicide, when we should be embracing it. Many private practitioners explicitly screen out suicidal clients during intake. Stories abound of clients whose therapists “fire” them following a suicide attempt. Our collective fear – of litigation, of loss, of the prospect of our ineffectiveness – dilutes our goal of helping others from a moral obligation to a convenient desire. I can’t say I blame us, either. Not entirely. Therapists get sued all the time, and the vicarious trauma and complicated grief therapists face after a client’s suicide can be crippling.

So yes, it can be tough sometimes. But it can also be inspiring, rewarding, and life-affirming. Besides, ignorance and fear make poor excuses for incompetence.

Instead of writing off clients who are suicidal, we should be welcoming with open arms those who most need our help.

Most people who are suicidal do want to live. The problem is that their lives have become unbearably painful, and when they look for a way out of their suffering, suicide appears to be the only way. My job is to help clients accept that alternatives exist and that life can be worth living.

That’s not a simple process, and improvement often needs to be measured in very small increments. But I’ve seen that improvement enough times now to know beyond a doubt that lives are saved. Not enough, but suicides are being prevented.

Being suicidal is not a death sentence, a permanent label, nor a crime, and I ask you to talk about it as such.

Consider what is meant by how you use the word “suicidal.” As a label, it can be misleading and damaging, and not just because of the usual weight of stigma and discrimination that comes with it. “Suicidal” implies a trait that gets permanently attached to a person, much like a diagnosis.

Using the word “suicidal” to mean a state is more accurate. States of being are temporary; they ebb and flow in intensity and duration. Someone researching ways to kill themselves or writing a suicide note today may find themselves in a better state tomorrow, or even an hour or two from now (this works in the other direction too, of course). Indeed, the whole point of acute suicide risk assessment is to predict what state of suicidality a person is likely to be in at any given time, which is difficult given the fluid nature of suicidality itself.

Above all though, remember to talk about hope, because hope above all other things cannot be taken away from a person, only given up or lost.

If you are in crisis, help is available. Tell a friend, a health professional, or call 1-800-SUICIDE to speak to a crisis line volunteer.